This pilot provided an important
opportunity to learn how to improve
the effectiveness of personalized
health planning and how to scale it.
The experiences in Boston and Bonham demonstrated that personalized
health planning can be integrated
into diverse primary care settings
with PACTs. The authors suggest
that the knowledge gained from this
project should be incorporated into
new pilots at various clinical settings
to determine the usefulness of the
PHP for clinical indications beyond
primary care. Specialty care clinics,
home-based primary care services,
and telehealth programs would be
potential clinical applications for
such pilots.

New pilots should be designed
de novo and be of sufficient length
to gain quantitative data on patient
activation and clinical outcomes.
Furthermore, future studies of personalized health planning should
obtain input from the patient using
Likert scales, surveys, and focus
groups to gauge and quantify patient satisfaction and outcomes with
the approach. Since patient engagement and better understanding of
patients’ holistic needs are central
to development of the PHP, patients
need to be educated about this new
approach to care and their active
role in it.

The choice of the tools, includ-ing the HRA instrument, materialsfor orienting patients to their moreactive role in their care, the PHI, thePHP template to document sharedgoals, and other avenues used to en-gage patients, require refinement toimprove their clarity, effectivenessof conveying the intended informa-tion, and ease of use. These stud-ies demonstrated the vital need toaddress the best means to engagepatients in understanding the valueof their health to them since theclinician visit is likely to be an op-portune teaching moment. Initialobservations suggested that patientsrespond with different degrees ofenthusiasm when given the oppor-tunity to be more engaged in theircare. Future pilots should clarifywhether these differences stem from(a) how the invitation is presented;(b) individual differences in person-ality and preferences; (c) perceivedclinical needs; or (d) unfamiliaritywith the collaborative personalizedhealth planning process.The alignment of personalizedhealth planning with outcomesdata in the CPRS is essential forwidespread adoption. Importantly,incentives and performance met-rics will need to be redesigned tosupport the intended outcomes ofusing personalized health plan-ning in clinical care. To that end,further investigation into the po-tential for cost savings associatedwith personalized health planninguse is warranted, especially givenstudies that suggest high lev-els of patient engagement resultin lower health care utilizationexpenditures. 27Additionally, wherever person-alized health planning is initiated,employees across all levels of thesystem would benefit from trainingin patient engagement techniquesand other means of attaining behav-ioral change. This would facilitatemore effective use of time duringthe clinical visit and improve boththe patient’s and the clinician’s sat-isfaction. Indeed, preliminary dataindicate that this approach in aSMA setting is greatly valued by thepatients.Figure 3. Circle of Health